CurrentUnitedHealthcarePolicy 2026R7133G

Telehealth/Telemedicine and virtual health reimbursement

Defines UnitedHealthcare Community Plan Medicaid reimbursement rules for telehealth, telemedicine, virtual health, CTBS, RPM and related services billed on CMS-1500 or UB-04 for all products and providers under the Community Plan Medicaid program.

Policy Summary

PayerUnitedHealthcare

PolicyTelehealth/Telemedicine and virtual health reimbursement

Policy CodePolicy 2026R7133G

Change TypeNo material clinical or coverage changes

Effective Dateas written

Next Review Date

Key ActionWhen submitting claims for telehealth services, report an appropriate telehealth modifier (GQ, GT, G0, or 95) and follow your state's attachment for any modifier and Place of Service exceptions.

SourceLink

Q3014Originating site facility fee recognized for reimbursement (with conditions)

Modifiers requiredTelehealth modifiers required (state exceptions apply)

Non-reimbursableTelephone-only CPT codes are non-reimbursable

ReimbursableOnline E/M and RPM codes recognized for reimbursement

Telehealth Reimbursement Criteria

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General reimbursement criteria for telehealth services

UnitedHealthcare Community Plan will consider for reimbursement telehealth services when ALL of the following are met:

ALL of the following

Procedure code is recognized by CMS PFS or AMA CPT as eligible for telehealth/virtual care or listed in the policy attachments.
An appropriate telehealth modifier is appended: GQ, GT, G0 (acute stroke) or 95 (subject to state exceptions).
State-specific originating site, place-of-service and modifier rules (see policy attachments/state exceptions) are followed.

Codes and Coding Guidance

Telehealth modifiers requiredModifier

GQ	Asynchronous telehealth modifier (recognized when appropriate)
GT	Synchronous interactive audio-visual telehealth modifier
G0	Telehealth modifier for acute stroke (numeric zero)
95	Synchronous telemedicine service via real-time interactive audio and video telecommunications system
93	Audio-only services (state-dependent use)

Non-reimbursable telephone service codesCPTNot Covered

98966	Non-face-to-face telephone E/M by physician or other qualified health care professional
98967	Non-face-to-face telephone E/M
98968	Non-face-to-face telephone E/M
98008	Telephone services (range 98008-98016) - non-reimbursable per policy
98009
98010
98011
98012
98013
98014

1–10 of 12

1/2

Online digital E/M and interprofessional consults (recognized)CPTCovered

99421	Online digital E/M service, 5-10 days
99422	Online digital E/M service, 11-20 days
99423	Online digital E/M service, 21+ days
98970	Online digital E/M by qualified nonphysician
98971
98972
99446	Interprofessional telephone/Internet E/M consults (99446-99449)
99447
99448
99449

1–10 of 12

1/2

Remote physiologic monitoring and related codesCPTCovered

99453	Initial set-up and patient education on use of equipment
99454	Device supply with daily recordings or programmed alert
99457	Remote physiologic monitoring treatment management services
99458	Each additional 20 minutes
99473	Self-measured blood pressure
99091	Collection and interpretation of physiologic data

Remote evaluation of recorded video/images and virtual check-insHCPCS/CPTCovered

G2010	Remote evaluation of recorded video/images (store-and-forward) with follow-up within 24 business hours
98016	Brief communication technology-based service/virtual check-in (5-10 minutes) - reimbursable per CMS PFS

Originating site facility feeHCPCS

Q3014

Telehealth originating site facility fee; reimbursable when telepresenter present and not for services with patient at home (exceptions apply)

Additional services recognized for telehealth (examples listed)CPT

96041	Medical genetics and genetic counseling services
98960	Education and training for patient self-management
98961
98962
99408	Alcohol/substance abuse screening and brief intervention
99409
G0508	Remote real-time interactive video-conferenced critical care E/M (use G0508/G0509)
G0509

Billing, Documentation and Operational Requirements

Billing Rule

Modifiers and POS reporting

When performing a service via telehealth, report an appropriate telehealth-associated modifier to identify the service and follow state-specific exceptions in the attachments for required modifiers and Place of Service codes.

Required modifiers: GQ, GT, G0, 95, 93
Consult the state-specific attachment for modifier and POS exceptions (some states require POS 02/10 or different modifier rules)

Billing Rule

Originating site billing

Report HCPCS Q3014 for the telehealth originating site facility fee on a CMS-1500 or UB-04 when a telepresenter is present at an originating site location other than the patient's home; Q3014 is not reimbursable when the distant site claim indicates POS 10 (home) unless a state-specific exception applies.

Bill Q3014 on CMS-1500 (professional) or UB-04 (facility) when telepresenter is present
Do not reimburse Q3014 if the distant site claim is reported with POS 10 (patient at home), except where attachments/state rules allow

Billing Rule

Non-reimbursable telephone-only services

Do not bill UnitedHealthcare Community Plan for telephone-only non-face-to-face E/M CPT codes 98966-98968 and 98008-98016; these are non-reimbursable and considered included in overall patient management (subject to limited state exceptions documented in attachments).

Non-reimbursable codes: 98966, 98967, 98968, 98008–98016
Some limited state exceptions may apply — consult the attachments for state-specific guidance

Documentation Required

Telehealth visit documentation

Document telehealth visits to the same extent as in-person visits and record that the encounter was done through audio-video telecommunications.

Documentation should reflect what occurred during the visit and note that it was furnished via audio‑video telecommunications

Billing Rule

Telehealth transmission and T1014

Do not separately bill HCPCS T1014 for telehealth/virtual health transmission per minute; T1014 is non-reimbursable and considered included in services.

T1014 (telehealth transmission per minute) is non-reimbursable per CMS PFS and included in other services

Policy Background and Scope

Defines UnitedHealthcare Community Plan Medicaid reimbursement rules for telehealth, telemedicine, virtual health, CTBS, RPM and related services billed on CMS-1500 or UB-04 for all products and providers under the Community Plan Medicaid program. This policy applies to services reported on the CMS-1500 and UB-04 (or electronic equivalents) and to all network and non-network providers and settings covered by UnitedHealthcare Community Plan Medicaid. Virtual health is defined broadly to include synchronous, asynchronous and Remote Physiologic Monitoring (RPM) care, encompassing Telehealth/Telemedicine, Communication Technology-Based Services (CTBS), electronic visits, Virtual Check-Ins, and interprofessional consults; Telehealth/Telemedicine specifically denotes live, interactive audio-visual (synchronous) encounters and the terms are used interchangeably in this policy.

Policy includes multiple state-specific attachments (state telehealth code lists and modifier/Place of Service rules) detailing allowable codes, required modifiers/POSes and exceptions for numerous states (examples: AZ, CO, FL, HI, ID, IN, KS, KY, MD, MI, NC, OH, PA, RI, TN, TX, VA, WA, WI, MS, MO, NJ, NM, NE and others). Providers are required to consult the attachment for their state’s specific rules to determine recognized procedure codes, applicable modifiers (e.g., GQ, GT, G0, 95, 93), originating site guidance (including use of HCPCS Q3014) and any state exceptions to modifier or Place of Service reporting.

Defined Terms

Definitions

Telehealth/TelemedicineLive, interactive audio and visual transmissions of a physician-patient encounter using telecommunications technology (synchronous); terms used interchangeably.

Virtual healthEncompasses synchronous, asynchronous and RPM care between health care professionals and patients, including CTBS, e-visits, virtual check-ins, interprofessional consults.

Originating SiteLocation of the patient at time the telehealth service is furnished; CMS-designated originating sites are recognized with state exceptions.

Distant SiteLocation of the physician or other qualified health care professional furnishing the service via telecommunications.

Communication Technology-Based Services (CTBS)Services furnished via telecommunications considered under virtual care but not considered telehealth services.

Remote Physiologic Monitoring (RPM)Collection of vitals and physiologic information by the patient transmitted to the health care professional for interpretation and monitoring.

Policy Summary

PayerUnitedHealthcare

PolicyTelehealth/Telemedicine and virtual health reimbursement

Policy CodePolicy 2026R7133G

Change TypeNo material clinical or coverage changes

Effective Dateas written

Next Review Date

SourceLink

On This Page

OpenPayer

Telehealth/Telemedicine and virtual health reimbursement

Telehealth Reimbursement Criteria

Codes and Coding Guidance

Billing, Documentation and Operational Requirements

Policy Background and Scope

Defined Terms

Policy History & Updates